A new era of digitalisation and connectivity, between everything and everyone, has the potential to change the fundamentals of human existence: the way we interact, produce, live and work. Driven primarily by technological forces that support new connectivity, computing and consuming paradigms, this fast-approaching socioeconomic transformation will cause changes to human behaviour, but also massive disruption to business models. Traditional industry sectors which are not yet digitalised and remain relatively unevolved are now embracing the incoming digital transformation. Indeed, the medical sector is embracing the transition towards digital health . 5G technology will supply the connectivity needed to support this transformation , enabling new applications and services, arising alongside novel value propositions in the “5G world” . In this paper, we aim to provide a review of 5G in digital health and to present a vision for the future of the digital healthcare sector.
5G is the fifth generation of cellular wireless technology. Its potential to transform how healthcare is delivered is vast, thanks to its ability to provide high speeds, support many connected devices and offer ultra-reliable and low latency connectivity (Figure 1) . Once fully deployed, its ubiquity will alleviate current inequalities in healthcare provision due to imbalanced distribution of resources . 5G has the capacity to both impact and enable medical innovation in several areas, including the Internet of Medical Things (IoMT), augmented reality (AR), virtual reality (VR), artificial intelligence (AI), remote medical learning and remote patient monitoring. The core features, and associated challenges, of 5G are summarised below:
In order to deliver on the above promises, 5G networks will operate seamlessly, across a set of heterogeneous network elements, with satellites playing a critical role in this evolution. Network convergence is the key to a future in which we will see new players emerging, such as Virtual Network Operators, pooling terrestrial and satellite services in different domains and use cases. Innovation and novel service development, benefiting from an integrated satellite and terrestrial service, will be required in each service domain.
The future of healthcare will likely be driven by digital transformation enabled by radically interoperable data and open, secure platforms (Figure 2) [8, 9]. Further, health is likely to revolve around sustaining well-being rather than simply responding to illness. Four concentric layers surrounding the patient have been suggested as a model for the future of healthcare, which describe the catalysts needed for change, the jobs which need to be done, the enablers, tasks and future business archetypes .
The next revolution in global healthcare will come hand-in-hand with the revolutionisation of global connectivity and interconnectivity. Together with most other aspects of society, healthcare is rapidly moving towards a decentralised system, making use of an exponentially increasing number of connected smart devices to achieve a more patient-centred care system . Given the vastly expanding virtual environment associated with the healthcare sector, it stands to benefit from 5G and its associated advance technologies. The focus of the next development in healthcare will be on big data. Moving to a decentralised system will result in a huge increase in data and subsequent data handling and processing; the limitations of current network infrastructure will be overcome by the deployment of 5G networks. Previous authors have highlighted the requirements and technologies trend of 5G-based healthcare [2, 7]. Select use cases of this technology, which are not exhaustive, are summarised here [2, 10]:
Doctors are beginning to have access to a whole new world of data, and patients can now be monitored from home. Whether wearable (and hence mobile) or stationary, connected medical devices allow medical professionals to access and analyse vast amounts of data in order to improve healthcare . Examples of connected medical devices are illustrated in Figure 3. The clear benefits of these ‘wearable doctors’ are: better patient care, improved insights, instant results, patients can stay home, quicker response time, and automatic supply control.
The challenges to overcome in order to allow for the widespread adoption of wearables are linked to safety and security . In particular:
Modern wearable devices that are in widespread use amongst the public can track our steps, sleep patterns and heart rate, and have been integrated into daily life in a matter of just a few years. We expect this to continue and accelerate over the coming years. The next generation of sensors might well switch from wearable devices to invisible and always-on sensors, embedded into the devices around us , as industries start striving towards ubiquitous connectivity between people and objects .
Digital healthcare companies have already begun incorporating these always-on sensors into devices capable of generating, gathering, and sharing their data. Advanced cognitive technologies could be utilised in an effort to analyse a large set of parameters to create personalised insights into an individual’s health status. The use of data and personalised AI for this reason, could enable real-time micro interventions that allow us to predict and prevent sickness, long before catastrophic disease arises.
There is no question that 5G will bring major boosts to global economy in the coming years : reports from Huawei, STL Partners and McKinsey predict that the technology will generate between $1.2–2 trillion in GDP for economies worldwide over the next decade [17, 24]. 5G advancements are directly addressing the diverse use cases available in IoT and in fact are moving onto Massive IoT (MIoT), focusing on truly vast numbers of connected devices. Applications of the MIoT are endless and include autonomous vehicles, industrial automation and indeed, telehealth.
Healthcare is one of the two industries set to benefit the most from advancements in connectivity with the other being manufacturing. These advancements offer massive commercial opportunities for hospitals, healthcare providers and the pharmaceutical industry. Further to healthcare workers, network operators and telecommunication providers too will benefit hugely. The European Union predicted the saving of €99 billion in annual healthcare spending and the addition of €93 billion to the EU GDP due to mobile health systems in 2017 . According to the report of Huawei, 5G will allow healthcare professionals to treat over 850 million more outpatients a year by 2030 .
In the year 2035, one source predicts that global sales activity across various industries enabled by 5G has the potential to reach $13.2 trillion – about 5% of all global real output in that year . When this is divided amongst the 16 major industry sectors (defined by the International Standard Industrial Classification of All Economic Activities, Revision 4 ), the healthcare sector will contribute a staggering $447 billion in 2035. Notably, there are three contributors to this economic benefit that 5G will bring to digital health: the sales of products and services enabled by 5G; the maturing of the 5G value chain through focused research and development efforts; and the potential for 5G to drive long-term, sustainable growth.
Investment in digital health is growing rapidly (Figure 4) . Primitive mobile health systems are already in place around the world and their impacts can be seen; annually, remote monitoring of the elderly saves €2.4 billion in Sweden, €1.25 billion in Denmark and €1.5 billion in Norway . Hence, the potential for net economic gain when more sophisticated forms of this technology are rolled out at scale is easy to see and the desire for interconnectivity and high-speed data transfer ensures its inevitability.
The increased service capabilities enabled by 5G connectivity will contribute to the development and adoption of different healthcare models. In particular, this leads to the rise of decentralisation in healthcare and the shift from healthcare to homecare [6, 29, 30]. This will in turn result in increasing dependence on wearable and remote diagnostics and treatments, making 5G essential for reliable and secure service provision. As healthcare becomes decentralised, patient data becomes of paramount importance and will become increasingly centralised, thereby effectively turning hospitals into data hubs.
The subsequent socioeconomic impact of this is the increased sustainability of healthcare, considering current worries around demographic trends of an ageing society with high healthcare costs . Decentralised healthcare also presents an opportunity to create improvements in patient’s quality of life, for example in areas such as chronic disease management. Decentralising healthcare reduces the costs, both monetary and in time, to access medical care, by removing waiting lists and logistical problems based on patient location. A 5G-enabled decentralised healthcare model would allow for remote consultation, diagnosis and treatment, making specialised and quality healthcare more accessible and affordable.
Notably, there is evidence that patients and doctors alike welcome online, remote consultations. When the Covid-19 pandemic hit, many people felt uncomfortable attending in-person appointments and indicated they would welcome more digital health services. A recent survey indicated that 60% of UK and US consumers are either already using a digital health service or would use one in the future, if available . Equally, 88% of general medical practitioners said they would like greater use of remote consultations in the future. The opportunities for use of 5G for digital healthcare are therefore particularly timely , and benefits of digital health appointments in the Covid-19 era also include increased accessibility to medical services and a reduction on the burden on medical professionals and hospitals .
This shift from healthcare to homecare and to a more decentralised model will also create new business opportunities. The future will focus on wellness and be managed by companies which proactively incorporate new roles which build value in the digital healthcare environment. These roles will be driven by greater data connectivity, interoperable and open, secure platforms, and increasing patient engagement. Successful companies will compete in one or more of the new business functions identified in Figure 5 (which expands on the outer layer shown in Figure 2) . Three main categories will prevail over this: data and platforms, well-being and care delivery, and care enablement. Within these, ten main business functions are expected to emerge. Organisations’ activities might spread over multiple functions, but multiple organisation types will be required to cover all archetypes in a category.
All the considerations presented in Section 3 (on the new 5G-enabled use cases) and Section 4 (on the 5G economy), assume that the availability of 5G is ubiquitous and that all customers (in this case, patients) have access to appropriate connectivity in order to benefit from the distributed healthcare system. Moreover, it also assumes that the myriad of medical instruments, devices, sensors and wearables will be securely connected all the time. For this to be the case, 5G will need to be universally available in city areas, as well as rural and remote areas, whether a patient is at home or walking outdoors and weather they are travelling by plane or by ship. For this reason, the provision of global ubiquitous, secure 5G communications will need to rely on a number of seamless interconnected networks. The 5G community is designing, standardising and implementing a layered network architecture which will drive the future of telecommunications for 5G and beyond. The architecture makes use of several interconnected networks, in order to achieve the required attributes of global coverage, capacity and security . Three layers are envisaged as shown in Figure 6.
These three layers are defined as:
This layered 5G network architecture allows the delivery of secure ubiquitous connectivity globally. It therefore represents the connectivity fabric which underpins the digital transformation and provision of digital health services . Further, it enables the shift to newly distributed patient-centric digital health ecosystems, integrating elements such as radical interoperability, big data analytics, cloud computing solutions, AI, blockchain and IoMT .
This paper provides a vision for the future of digital healthcare. It illustrates the profound digital transformation ongoing in the sector and emphasises the empowering effect of connectivity. In particular, it highlights the impact of 5G telecommunications in reshaping the provision of digital healthcare services and corresponding socioeconomic impacts. The evolution of the roles and business functions of the healthcare ecosystem is presented, which will enable new value chain models and actors, ultimately leading to a patient-centric health system which will result in a healthier population with reduced healthcare spending.
Please note that the views, opinions and ideas expressed in this article are solely those of the authors and do not necessarily reflect the official policy or positions of the European Space Agency, the University of Toronto or The University of Sheffield.
The authors have no competing interests to declare.
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